Lifestyle changes improve NAFLD

Al-Jiffri, 2013

Exercise + Diet

No

13 weeks

EX: 5-minute warm-up phase on the treadmill. Endurance training session for 30 minutes. 5-minute recovery

No intervention

liver enzymes, HOMA-IR, insulin

↓BMI*☨

↓ALP, ALT, AST,

GGT*☨

↓HOMA-IR*☨

D: low calorie diet (1200 kcal): 15% as protein, 30 to 35% as fat and 50 to 55% as CHO

Arab, 2017

Exercise + Diet

No

9 weeks

Eight lifestyle sessions about healthy eating and regular physical activity for 5 days/week

Usual care

Weight, BMI, other body composition measures

↓Weight*

↓BMI*☨

↓Abdominal circumference*

↓Lean body mass*

↓Percent of body fat*

Cheng, 2017

Exercise + Diet

Yes

37 weeks

AER: Progressive aerobic training program. 5 min warm-up, 30–60 minutes session, 5 minutes cool-down. 65 to 70% of VO2max.

No intervention

HFC, HbA1c, insulin sensitivity, body composition, total cholesterol, liver enzymes

↓HFC*☨

↓Weight (only in AED group)

↓FM☨

↓fat% ☨

↓HbA1c (only AED group)

D: 30–40%of the total daily energy intake. 37–40% CHO, 9–13 gr as fiber, 35–37% fat, 25–27% protein. Maintain personal physical activities

AED: AER + D protocols.

Dong, 2016

Exercise + Diet

Yes

104 weeks

D: Negative calorie balance of (25–30 c/kg/d) for overweight and obese. Neutral calorie balance (30–35 c/kg/d) for normal BMI. 20–30% fat, 15–20% protein, 50–60% CHO

Lifestyle counseling

Weight, liver enzymes, IHL content, lipid profile, fasting plasma glucose

↓Weight*

—BMI

↓NAFLD fibrosis score*

↓ALT*, —AST, —GGT

↓TC*, —TG,

HDL*, LDL*

EX: Favorite aerobic exercise or activity, moderate intensity (60–80% of heart rate) to vigorous (>80%).

Eckard, 2013

Exercise + Diet

Yes

26 weeks

D: Nutrition prescription based on individualized calorie needs subtracting 500 kcal/day and macronutrient distribution

Standard care

Liver biopsy (NAS), body composition, lipid profile, liver enzymes, HbA1c, glucose, insulin

—Weight

—Fat mass %

↓NAS*

↓ALT, AST*

—Fasting glucose

—Insulin

EX: Education about exercise based on ACSM’s recommendations.

Katsagoni, 2018

Exercise + Diet

Self-monitoring

26 weeks

Energy restriction regimen. 45% CHO, 20% protein, 35% lipids. 1500 kcal women, 1800 kcal men.

Energy restriction regimen. 45% CHO, 20% protein, 35% lipids. 1500 kcal women, 1800 kcal men + general written dietary guidelines for a healthy lifestyle.

Weight, BMI, WC, ALT, GGT, Liver stiffness, NAFLD fibrosis score, glucose, insulin, HOMA-IR, lipid profile

↓Weight*☨

↓BMI*☨

↓Liver stiffness*☨

↓ALT only in MLG group*

MDG: Seven 60-min small group sessions about improving diet quality and energy restriction held every 2 weeks for the first 2 months and every month for the next 4 months.

MLG: MDG + enhancing activity through a moderate–vigorous intensity physical activity program as well as for optimal sleep duration and mid-day rest.

—HOMA-IR

↓LDL only MDG group*

—blood pressure

↑Adherence to intervention*

Promrat, 2010

Exercise + Diet

No

48 weeks

Weight loss intervention based on different strategies used successfully in other trials (diet, exercise, and behavior changes)

Small group sessions providing basic education about NASH, healthy eating, physical activity, and weight control.

Weight, BMI, ALT, AST, TC, LDL, HDL, TG, glucose, HbA1c, insulin, HOMA

↓Weight*☨

↓WC*☨

↓NAS*☨

↓ALT*☨

— HOMA, insulin, HbA1c

Sun, 2012

Exercise + Diet

No

12 weeks

Diet: 30% fat, 15% proteins and 55% carbohydrates, including 5% sugar. Energy intake: 25–30 kcal/kg. EX: walking, jogging, stair climbing and physical exercise, 23 (METs)•h/week (physical activity) + 4 METs•h/week (exercise).

Basic education about NAFLD and principles of healthy eating, physical activity, and weight control

Weight, BMI, WC, ALT, AST, GGT, TC, TG, fasting glucose, HOMA-IR, visceral fat area

↓Weight*☨

↓BMI *☨

↓WC*☨

↓ ALT*☨

↓ AST, GGT*

— TG, TC, fasting glucose

↓HOMA-IR*☨

↓VFA*☨